Individual
DR. KELLIE BROOK HAWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
262 DANNY THOMAS PL, MEMPHIS, TN 38105-3678
(901) 595-4925
(901) 595-9005
Mailing address
262 DANNY THOMAS PL, MEMPHIS, TN 38105-3678
(901) 595-4925
(901) 595-9005
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
35.098813
OH
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
35.098813
OH
2080P0207X
Pediatric Hematology & Oncology Physician
35.098813
OH
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
56657
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0123305
—
OH
Enumeration date
07/23/2007
Last updated
11/15/2018
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